Chagas disease, also known as American Trypanosomiasis, can result in heart disease and fatal cardiomyopathy (CM) in 30% of those infected1. The disease is caused by an infection with the parasite Trypanosoma cruzi (T. cruzi), with the most common route of transmission being through the triatomine kissing bug vector at the time of a blood meal. Chagas is the leading cause of dilated CM in Latin America, with more than 10 million people estimated to be infected. A recent study in New York City found 13% of Latin American immigrants with dilated CM were positive for Chagas. In the United States, we are finding mounting evidence of disease transmission within Texas, with more than 267,000 people in the state estimated to be chronically infected and at risk for dilated CM. Unfortunately, epidemiologic and clinical studies are severely lacking, and the true burden of disease has not been elucidated. Identification of Chagas cases is essential to (1) improve clinical outcomes through treatment and monitoring of infection, (2) better understand the epidemiology and transmission dynamics of the disease in Texas, and (3) identify high risk populations to target for early screening, prevention, and intervention. The overall goal of this study is to determine the prevalence and risk of Chagas disease in patients presenting with dilated CM to three major hospitals in Houston, Texas. We have put together a strong, multi-disciplinary team to assess clinical impact of cardiac disease in those identified as positive and determine demographic, geographic, and social risk factors for acquiring infection by comparing to patients enrolled in the study who test negative. We hypothesize that Chagas disease is responsible for disease in a higher than expected proportion of patients presenting with non-ischemic dilated CM, with immigrants and people living in poverty in Texas being at highest risk for infection. The long-term goals of this exploratory pilot study are to use the data derived from screening and clinical evaluations to identify high risk populations to target for prevention/intervention and establish a clinical cohort for a longitudinal study to establish prognostic biomarkers and assess clinical outcomes following treatment. At this time, physicians in the United States rarely test dilated cardiomyopathy patients for Chagas; therefore, the results of this study will critically impact the clinical understanding of Chagas disease on cardiovascular health in Texas, with an opportunity to identify high risk populations to target for prevention, intervention, and treatment efforts.